The mental health system and the children within it

Shocking, but sadly not uncommon. These were my initial thoughts when reading about Matthew Garnett – the 15 year old boy with a diagnosis of autism, ADHD and anxiety.

Matthew’s family like many others were probably facing a very difficult decision to agree to his detention under the Mental Health Act. For parents, this decision is a last resort and not one taken lightly. When the Mental Health Act assessment takes place and the nearest relative is required to consent to detention for treatment (initially a six month period), it is often given after long reassurances from psychiatrists and social workers that this is the best option and after those six months of intensive treatment, it is most likely that the young person will return home, or to a specialist supported placement nearby.

In my capacity as a mental health solicitor, I always see the aftermath – that being some six months down the line when the family are asking for their son or daughter to come home to be told that either they are not ready for discharge (for a number of clinical reasons), or, they have made good progress, but there is not the relevant aftercare available in the community to meet their needs, and as such, they must remain in hospital until such time aftercare can be obtained and put in place.

Unfortunately, for Matthew and his family, that journey has not yet begun. How on earth can any appropriate treatment be given in a PICU? Matthew already feels like he is being punished and not helped and I cannot begin to imagine the irretrievable impact this has had on both Matthew and his family. Therefore, it is inevitable that his treatment pathway will take even longer due to the amount of time it has taken to move him to an appropriate unit.

According to a recent Care Quality Commission (CQC) report, when the CQC visited two patients who were in long-term segregation on a Child and Adolescents’ Mental Health Services (CAMHS) ward, both patients were assessed as requiring treatment in a medium secure unit. Funding was agreed for this by their home areas. However, the hospital managers and staff were frustrated that the transfers were delayed because of a lack of suitable beds. Whilst both patients were moved within eight weeks of the CQC visit, the CQC reported that “such delays may seriously inhibit the recovery process”.

The CQC also noted in their report that “we are still finding problems in services’ approaches to children with mental health needs. In part, these stem from gaps in the provision of child and adolescents’ mental health services (CAMHS) that have been acknowledged by NHS England”. Despite NHS England’s report on CAMHS recognising that placing a patient in hospital can itself lead to adverse care pathways for some people in the CAMHS system and warns putting someone in hospital because of concerns that they are a risk to themselves can lead to a spiral of worsening symptoms and increased suicidality, leading to increasing levels of security, and delayed discharge for some young people. I would still beg the question (or two): What is being done to improve in-patient services for children?; Why is there still a lack of suitable in-patient provisions for young people in the UK?

In my experience, despite having those responsible for placing patients in an appropriate setting for treatment, made to attend a Tribunal hearing to give evidence, or to adhere to strict directions, this all takes time. Yet it is not good enough to say “it takes time” or “there are no beds available”. These young people are suffering enough being placed in an inappropriate setting.

Unfortunately, due to a severe lack of resources for young people suffering with mental health problems, many children are placed hundreds of miles from home. I have seen numerous times the effect this has on the young person and also their families. Many of my young clients have been placed at a specialist unit in Northampton and it is difficult for them to maintain family contact regularly, other than over the telephone, as their family are in places like Scotland, Cornwall or even Northern Ireland. It would seem that in the South West of England there is only a small 12 bedded unit in Plymouth which is aimed at short-term assessment and treatment. If that unit is full, which most of the time it is, then where are the young people requiring in-patient treatment sent? Usually, to London, Newcastle or, Northampton. This cannot be the future of mental health care and a lack of resources can no longer be an excuse.

At Chilcotts Law we specialise in Mental Health Law. If you have any questions about detention under the Mental Health Act or your rights in this area, please contact us.